A harness for treatment of congenital hip dislocation in infants

Abstract

Background Treatment of DDH was reduction and holding the hip reduced using a cast or brace. Four types of methods were recognised before Professor Pavlik started using his harness in 1945: Lorenz method, Hanausek method, Hanausek's and Frejka's blanket. These methods were associated with a high risk of osteonecrosis (28 %). Professor Pavlik attributed this to the fact that these methods provided a rigid reduction and did not allow active movement of the hip, which was the cause for the osteonecrosis developing. Hence he developed a new method to keep the hip reduced but still retaining some form of active movement of the hip. He called his new method "active movement". Methods A retrospective series of 245 dislocated hips in 176 children treated with "active movement" using the harness. Two months were allowed to spontaneously reposition the dislocated hips. Failure of spontaneous repositioning in that time was an indication for repositioning and immobilisation with either a splint, abductive device or plaster cast. Results Treatment of dislocations with active movement using the harness resulted in spontaneous reduction in 206 dislocated hips that is 84.1 %. In 39 dislocated hips (15.9 %) spontaneous reposition did not occur in the two months period and these dislocations were subsequently treated in combination with passive mechanical intervention. Dislocations treated with active movement only with the aid of the harness showed <1 % necrosis of the femoral head but dislocations treated in combination with immobilisation showed 17.9 % necrosis of the femoral head. Conclusions Dr. Pavlik concluded that necrosis of the femoral head did not occur if a dislocated hip had movement and if spontaneous reposition occurred. He stated that any immobilisation of a passively repositioned hip threatened the femoral head signifi cantly. The author believed that this occurs when the femoral head encounters a large obstacle in the socket.